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Clinical Slit Lamp Biomicroscopy and Photo Slit Lamp Biomicrography
652
AMERICAN JOURNAL OF OPHTHALMOLOGY
their antibiotic susceptibility pattern is more consistent with S. aureus than S. epidermidis. Staphylococcus aureus is generally ac cepted as one of the leading ocular pathogens and virtually every laboratory speciates this bacterium. However, the speciation of the coagulase-negative staphylococci is not a simple procedure using the conventional methods de scribed by Schleifer and Kloos. 2 The API Staph-Ident system simplifies the task considerably, but equivocal results are not uncommon, and supplemental testing is often needed. 3 We have tested a number of ocular isolates of coagulase-negative staphylococcal strains and found the majority to be S. epidermidis. We believe that until the speciation methods can be simpli fied and the pathogenic potential of the various coagulase-negative staphylococci more clearly established, mannitol salt agar may be an alternate to speciation. Many years ago Thygeson 4 recommend ed this medium as an indicator of conjunctival pathogenicity of staphylococci, and mannitol-positive colonies on this medium are with few exceptions, S. au reus, S. warneri, or S. hemolyticus. We have also noted that coagulase-negative but mannitol-positive staphylococci are much more likely to be associated with clinical disease. MASAO OKUMOTO, G I L B E R T SMOLIN, MAGDA SUMY, W E N H U A ZHANG,
San Francisco,
M.A. M.D. M.D. M.D.
California
REFERENCES
1. Skerman, V. B. D., McGowan, V., and Sneath, P. H. A.: Approved lists of bacterial names. Int. J. Syst. Bact. 30:225, 1980. 2. Schleifer, K. H., and Kloos, W. E.: Isolation and characterization of staphylococci from human skin. Int. J. Syst. Bact. 25:50, 1975. 3. Almeida, R. J., and Jorgensen, J. H.: Identifi cation of coagulase-negative staphylococci with the
NOVEMBER, 1984
API Staph-Ident System. J. Clin. Microbiol. 18:254, 1983. 4. Thygeson, P. : Mannitol fermentation as an indi cator of conjunctival pathogenicity of staphylococci. Arch. Ophthalmol. 20:274, 1938.
Reply EDITOR:
We agree with the comments regard ing the usefulness of mannitol salt agar as a technique for screening staphylococcal species. Okumoto and associates also imply the need to establish more clearly the pathogenetic potential of the various coagulase-negative staphylococ ci. In order to clarify this relationship, it is necessary for medical centers to perform the precise speciation when possible (as well as minimal inhibitory concentrations for antibiotic susceptibili ty) and correlate the findings to clinical disease. As stated in our original letter, this speciation may prove to be particu larly important in managing intraocular infections. ANDREW J. PACKER, FRANKLIN P. KOONTZ,
M.D. M.D.
Iowa City,
Iowa
BOOK REVIEWS Edited by H. Stanley Thompson, M. D.
Clinical Slit Lamp Biomicroscopy and Photo Slit Lamp Biomicrography. By Csaba L. Martoni, Charles F. Bahn, and Roger F. Meyer. Journal of Oph thalmic Photography, June 1984, vol. 7, No. 1, Kenneth E. Fong, ed. Softcover, 80 pages, index, illustrated. $10
Reviewed by JOHN J. PURCELL
St. Louis,
Missouri
This excellent special tutorial issue of the Journal of Ophthalmic Photography is
BOOK REVIEWS
VOL. 98, NO. 5
devoted to clinical slit-lamp biomicroscopy and photo slit lamp biomicrography. This is the most clearly written and beau tifully illustrated text available on the subject. Each of the magnificent color slit-lamp photographs is supported by a clear diagram showing how it was taken and how the light sources had to be placed in order to achieve this kind of result. A section on special techniques clearly outlines the use of accessory lenses, vital dyes, and other techniques. An appendix summarizes the technical features (in cluding cost) of the currently available photo slit-lamp biomicroscopes and pho tographic attachments. This text is highly recommended for anyone interested in the techniques of slit-lamp examination and slit-lamp pho tography. Those confused by other dis cussions, such as "sclerotic scatter" and "specular reflection," need look no fur ther. Every ophthalmology resident should own this text. The authors are to be congratulated on their achievement.
Computerized Tomography in Orbital Disease and Neuro-Ophthalmology. By Robert G. Peyster and Eric D. Hoover. Chicago, Year Book Medical Publish ers, Inc., 1984. 300 pages, index, illus trated. $85 Reviewed by THOMAS L. Pittsburgh, Pennsylvania
SLAMOVITS
The authors, both neuroradiologists, set out to present and interpret a collec tion of high-resolution computed tomographic images, demonstrating a large variety of lesions that affect the visual system. For the most part they have succeeded admirably. Their book is likely to benefit neurosurgeons, neurologists,
653
radiologists, and, most certainly, oph thalmologists. The book contains 17 chapters, and has a good list of up-to-date references. The introductory chapter sums up the advan tages of high-resolution computed tomographic scanning. It offers the authors' rational approach to imaging, explaining their preference for direct coronal imag ing over coronal reformatting, the use of intravenous contrast in most instances, and use of ultrathin sections for specific areas such as the cavernous sinus and intraorbital optic nerves. Four major parts are devoted to the orbit, sella, posterior visual pathways, and ocular motility disorders. All four sections are good, but the ones on the orbit and sella are clearly superior. The introductory chapters on orbital and sellar computed tomographic technique and anatomy are superb. I highly recommend them to all ophthalmologists. In each chapter there are examples of most of the common and many of the more unusual lesions. The images are sometimes small, but this is a reasonable compromise made by the authors when multiple contiguous sections are shown to make a particular point. Overall, the quality of images is good, the labeling is clear, and the comments that follow are full of useful teaching points. Part I, on the orbit, demonstrates the variety of tumors originating primarily in the orbit or involving it by contiguous spread or metastasis. Many examples are presented of inflammatory, infectious, vascular, and traumatic lesions. The various causes of extraocular mus cle enlargement are discussed in different chapters throughout the book. It might have been helpful to devote a specific chapter to the extraocular muscles; this would have allowed a comparison of the neuroradiologic features distinguishing the various entities. Part II, covering the sella, is superb.
AMERICAN JOURNAL OF OPHTHALMOLOGY
their antibiotic susceptibility pattern is more consistent with S. aureus than S. epidermidis. Staphylococcus aureus is generally ac cepted as one of the leading ocular pathogens and virtually every laboratory speciates this bacterium. However, the speciation of the coagulase-negative staphylococci is not a simple procedure using the conventional methods de scribed by Schleifer and Kloos. 2 The API Staph-Ident system simplifies the task considerably, but equivocal results are not uncommon, and supplemental testing is often needed. 3 We have tested a number of ocular isolates of coagulase-negative staphylococcal strains and found the majority to be S. epidermidis. We believe that until the speciation methods can be simpli fied and the pathogenic potential of the various coagulase-negative staphylococci more clearly established, mannitol salt agar may be an alternate to speciation. Many years ago Thygeson 4 recommend ed this medium as an indicator of conjunctival pathogenicity of staphylococci, and mannitol-positive colonies on this medium are with few exceptions, S. au reus, S. warneri, or S. hemolyticus. We have also noted that coagulase-negative but mannitol-positive staphylococci are much more likely to be associated with clinical disease. MASAO OKUMOTO, G I L B E R T SMOLIN, MAGDA SUMY, W E N H U A ZHANG,
San Francisco,
M.A. M.D. M.D. M.D.
California
REFERENCES
1. Skerman, V. B. D., McGowan, V., and Sneath, P. H. A.: Approved lists of bacterial names. Int. J. Syst. Bact. 30:225, 1980. 2. Schleifer, K. H., and Kloos, W. E.: Isolation and characterization of staphylococci from human skin. Int. J. Syst. Bact. 25:50, 1975. 3. Almeida, R. J., and Jorgensen, J. H.: Identifi cation of coagulase-negative staphylococci with the
NOVEMBER, 1984
API Staph-Ident System. J. Clin. Microbiol. 18:254, 1983. 4. Thygeson, P. : Mannitol fermentation as an indi cator of conjunctival pathogenicity of staphylococci. Arch. Ophthalmol. 20:274, 1938.
Reply EDITOR:
We agree with the comments regard ing the usefulness of mannitol salt agar as a technique for screening staphylococcal species. Okumoto and associates also imply the need to establish more clearly the pathogenetic potential of the various coagulase-negative staphylococ ci. In order to clarify this relationship, it is necessary for medical centers to perform the precise speciation when possible (as well as minimal inhibitory concentrations for antibiotic susceptibili ty) and correlate the findings to clinical disease. As stated in our original letter, this speciation may prove to be particu larly important in managing intraocular infections. ANDREW J. PACKER, FRANKLIN P. KOONTZ,
M.D. M.D.
Iowa City,
Iowa
BOOK REVIEWS Edited by H. Stanley Thompson, M. D.
Clinical Slit Lamp Biomicroscopy and Photo Slit Lamp Biomicrography. By Csaba L. Martoni, Charles F. Bahn, and Roger F. Meyer. Journal of Oph thalmic Photography, June 1984, vol. 7, No. 1, Kenneth E. Fong, ed. Softcover, 80 pages, index, illustrated. $10
Reviewed by JOHN J. PURCELL
St. Louis,
Missouri
This excellent special tutorial issue of the Journal of Ophthalmic Photography is
BOOK REVIEWS
VOL. 98, NO. 5
devoted to clinical slit-lamp biomicroscopy and photo slit lamp biomicrography. This is the most clearly written and beau tifully illustrated text available on the subject. Each of the magnificent color slit-lamp photographs is supported by a clear diagram showing how it was taken and how the light sources had to be placed in order to achieve this kind of result. A section on special techniques clearly outlines the use of accessory lenses, vital dyes, and other techniques. An appendix summarizes the technical features (in cluding cost) of the currently available photo slit-lamp biomicroscopes and pho tographic attachments. This text is highly recommended for anyone interested in the techniques of slit-lamp examination and slit-lamp pho tography. Those confused by other dis cussions, such as "sclerotic scatter" and "specular reflection," need look no fur ther. Every ophthalmology resident should own this text. The authors are to be congratulated on their achievement.
Computerized Tomography in Orbital Disease and Neuro-Ophthalmology. By Robert G. Peyster and Eric D. Hoover. Chicago, Year Book Medical Publish ers, Inc., 1984. 300 pages, index, illus trated. $85 Reviewed by THOMAS L. Pittsburgh, Pennsylvania
SLAMOVITS
The authors, both neuroradiologists, set out to present and interpret a collec tion of high-resolution computed tomographic images, demonstrating a large variety of lesions that affect the visual system. For the most part they have succeeded admirably. Their book is likely to benefit neurosurgeons, neurologists,
653
radiologists, and, most certainly, oph thalmologists. The book contains 17 chapters, and has a good list of up-to-date references. The introductory chapter sums up the advan tages of high-resolution computed tomographic scanning. It offers the authors' rational approach to imaging, explaining their preference for direct coronal imag ing over coronal reformatting, the use of intravenous contrast in most instances, and use of ultrathin sections for specific areas such as the cavernous sinus and intraorbital optic nerves. Four major parts are devoted to the orbit, sella, posterior visual pathways, and ocular motility disorders. All four sections are good, but the ones on the orbit and sella are clearly superior. The introductory chapters on orbital and sellar computed tomographic technique and anatomy are superb. I highly recommend them to all ophthalmologists. In each chapter there are examples of most of the common and many of the more unusual lesions. The images are sometimes small, but this is a reasonable compromise made by the authors when multiple contiguous sections are shown to make a particular point. Overall, the quality of images is good, the labeling is clear, and the comments that follow are full of useful teaching points. Part I, on the orbit, demonstrates the variety of tumors originating primarily in the orbit or involving it by contiguous spread or metastasis. Many examples are presented of inflammatory, infectious, vascular, and traumatic lesions. The various causes of extraocular mus cle enlargement are discussed in different chapters throughout the book. It might have been helpful to devote a specific chapter to the extraocular muscles; this would have allowed a comparison of the neuroradiologic features distinguishing the various entities. Part II, covering the sella, is superb.